Vertigo is one of the most common causes of dizziness. It is distinctly different from other types of dizziness. With vertigo, a patient feels a spinning or moving sensation. The room or floor can feel like it is moving or the patient may feel a spinning or off balance sensation. Vertigo can sometimes be associated with nausea or vomiting. If severe, walking can be affected with the patient having staggering or inability to walk.
Vertigo has many causes but the most common include head trauma, ear infection and Meniere’s disease. Vertigo can frequently occur spontaneously, without a cause, and this is called benign positional vertigo (BPV.) Temporary vertigo can be experienced after getting off an amusement park ride or going out boating (sea sickness.) Meniere’s disease is a condition of sudden episodes of severe vertigo associated with progressive hearing loss. Stroke is a relatively rare cause of dizziness.
The cause of benign positional vertigo is quite simple. In the inner ear, our balance center, are the semicircular canals. These canals contain fluid that moves when we move, stimulation motion sensitive hair-nerve cells. It is this mechanism that gives us balance and allows up to keep from falling. Inside the area that contains the semicircular canals are small calcium crystals. When one of these crystals breaks off from the wall of the labyrinth, they move into the semicircular canal. With changes in head position such as rolling over, getting out of bed, bending, looking up or looking suddenly to one side, the calcium crystal (canalith) moves, abnormally disturbing motion-sensitive hair cells. This is what gives the sensation of vertigo or feeling dizzy. The vertigo associated with BPV is usually short in duration. In more severe cases patients can be disabled. A condition known as labyrinthitis is a severe form of vertigo, caused by inflammation of the labyrith. It needs to be differentiated from stroke. A CT or MRI brain scan should be performed.
Treatment of vertigo consists mostly of medication control of symptoms. Meclizine is the standard drug used for symptomatic treatment of vertigo. It is safe, effective and nonhabit forming. The usual dose is 25 mg one to four times daily. Drowsiness is the major side effect. For patients who do not respond to meclizine, very low dose Valium (1 mg) can frequently be effective.
There is nonpharmaceutical treatment of vertigo. This requires the affected patient to do Epley Exercises 2-3 times daily. This has the effect of repositioning the calcium crystal and fatiguing vertigo response. This You Tube video has an excellent demonstration of these exercises. The American Academy of Neurology recently published guidelines for treatment of vertigo. The medical evidence is strongly in favor of physician administered canalith repositioning. This was the most effective treatment available.
In summary, most causes of vertigo are benign but the symptoms can be disabling. Sometimes it is important to rule out more serious causes of vertigo such as stroke or brain tumor. Affected individuals should seek out care from a neurologist or other physician familiar with the treatment of vertigo.